Healthcare Provider Details

I. General information

NPI: 1932330172
Provider Name (Legal Business Name): MICHAEL WILLIAM KOCH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 07/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RANDOLPH ST
THOMASVILLE NC
27360-5716
US

IV. Provider business mailing address

901 RANDOLPH ST
THOMASVILLE NC
27360-5716
US

V. Phone/Fax

Practice location:
  • Phone: 336-476-1133
  • Fax: 336-476-1136
Mailing address:
  • Phone: 336-476-1133
  • Fax: 336-476-1136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16207
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: